Provider Demographics
NPI:1578896486
Name:PASSPORT HEALTH
Entity Type:Organization
Organization Name:PASSPORT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LOZARES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-293-3963
Mailing Address - Street 1:2525 CAMINO DEL RIO S STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3784
Mailing Address - Country:US
Mailing Address - Phone:619-293-3963
Mailing Address - Fax:619-293-3936
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 325
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3784
Practice Address - Country:US
Practice Address - Phone:619-293-3963
Practice Address - Fax:619-293-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center